Research Reports - Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population

PURPOSE: Hyperglycemia is a common secondary insult associated with an increased
risk of mortality and poor outcome in traumatic brain injury (TBI), but the
effect of hyperglycemia on outcomes of severe TBI in children and adolescents is
less apparent. The aim of this study was to evaluate the association of
hyperglycemia with mortality in pediatric patients with severe TBI.
METHODS: In this cross-sectional study, data of all children and adolescents with
severe TBI admitted to Poursina Hospital in Rasht, including age, gender, Glasgow
Coma Scale (GCS) upon admission, mortality rate, hospital length of stay, and
serial blood glucose during the first three consecutive ICU days following
admission, were reviewed from April 2007 to May 2011. After univariate analysis
and adjustment for related covariates, logistic regression model was established
to determine the association between persistent hyperglycemia and outcome.
RESULTS: One-hundred and twenty-two children were included with a median
admission GCS of 6 (interquartile range (IQR) 5-7) and a median age of 13 years
(IQR 7.75-17). Among them, 91 were boys (74.6 %) and 31 were girls (26.6 %); the
overall mortality was 40.2 % (n = 49). Patients who died had a significantly
greater blood glucose levels than survivors for the first 3 days of admission
(P = 0.003, P < 0.001, P = 0.001, respectively). Moreover, persistent
hyperglycemia during the first 3 days of admission had an adjusted odds ratio of
11.11 for mortality (P < 0.001).
CONCLUSION: Early hyperglycemia is associated with poor outcome, and persistent
hyperglycemia is a powerful and independent predictor of mortality in children
and adolescents with severe TBI.